Soehendra N, Grimm H, Maydeo A, Nam V C, Eckmann B, Brückner M
Department of Endoscopic Surgery, University Hospital of Hamburg, Germany.
Hepatogastroenterology. 1991 Jun;38(3):220-3.
Over the last 12 years, treatment of bleeding esophageal and gastric varices has improved considerably. By the use of new techniques and with increased experience the results of endoscopic sclerotherapy have been optimized. Acute variceal bleeding, esophageal or gastric, can now be reliably and definitively stopped using the tissue adhesive Histoacryl Blau. This is also applicable to all patients irrespective of their liver status at presentation. As expected, the mortality of acute variceal bleeders has decreased considerably, no death from bleeding occurring in the last 5 years. This has obviated the need for emergency surgery, balloon tamponade or vasopressin infusion. Using an aggressive sclerotherapy technique in the bleeding-free interval, varices of all grades can now be effectively eliminated within an average of 3 sessions covering 3-4 weeks. With the intra- cum peri-variceal injection technique not only are the visible veins eradicated, but also fibrosis of the inner esophageal wall is achieved at the same time. If careful attention is paid to certain details of the technique and instruments, and with close follow-up, patients of portal hypertension can now live well in terms of liver function, without the danger of further variceal bleeding.
在过去12年里，食管和胃静脉曲张出血的治疗有了显著改善。通过新技术的应用和经验的积累，内镜硬化治疗的效果得到了优化。现在，使用组织粘合剂Histoacryl Blau能够可靠且确切地止住食管或胃的急性静脉曲张出血。这适用于所有患者，无论其就诊时的肝脏状况如何。不出所料，急性静脉曲张出血患者的死亡率大幅下降，过去5年中未发生因出血导致的死亡。这使得急诊手术、气囊压迫或血管加压素输注不再必要。在无出血间期采用积极的硬化治疗技术，现在平均3至4周内进行3次治疗，所有分级的静脉曲张都能有效消除。采用静脉曲张内及周围注射技术，不仅可以消除可见静脉，同时还能使食管内壁纤维化。如果仔细关注技术和器械的某些细节，并密切随访，门静脉高压患者现在在肝功能方面可以良好生活，而无进一步静脉曲张出血的危险。
